Dyslipidemia: The untreated metabolic dysfunction in people with type 2 diabetes in Latin America. ARETAEUS study outcomes

Objective

To assess oral antihyperglycemic agents (OAHA) and/or statin treatment initiation in patients with type 2 diabetes (T2D) and time from diagnosis to both types of treatment initiation and intensification.

Research design and methods

We reviewed 662 retrospective medical records of patients with T2D diagnosed by 31 general practitioner or specialist sites across Mexico, Argentina, and Brazil. Demographic and clinical information was abstracted from patients’ medical records and summarized using descriptive statistics. Between-group differences were assessed with Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. The starting time of each therapy (OAHA and statins, separately) was assessed using Kaplan-Meier estimates.

Results

At diagnosis, patients’ mean age was 53 years; 44% had hypertension, 42% were obese, and 23% had dyslipidemia. During the 2-year follow-up, 95% of patients received OAHAs but only 29% of those eligible for statins received this prescription. Mean ± SD and median (Q1, Q3) time to first OAHA was 59 ± 141 days and 1 (1, 31) day, respectively, and 230 ± 232 days and 132 (30, 406) days, respectively, for a statin. During follow-up, 51–53% of patients with HbA1c/FPG values above target did not intensify hyperglycemia treatment.

Conclusion

Dyslipidemia treatment in patients with T2D was delayed despite its known deleterious effect on atherosclerosis development and β-cell mass/function. Anti-hyperglycemic treatment was not intensified when targets were not attained. This prescriptive inertia needs to be corrected because attainment of HbA1c treatment goals becomes more difficult, favoring the development of diabetes complications.

A randomized, placebo-controlled study of the cardiovascular safety of the once-weekly DPP-4 inhibitor omarigliptin in patients with type 2 diabetes mellitus

Background

Omarigliptin is a once-weekly (q.w.) oral DPP-4 inhibitor that is approved for the treatment of patients with type 2 diabetes mellitus (T2DM) in Japan. To support approval of omarigliptin in the United States, the clinical development program included a cardiovascular (CV) safety study. Subsequently, a business decision was made not to submit a marketing application for omarigliptin in the United States, and the CV safety study was terminated. Herein we report an analysis of data from that early-terminated study.

Methods

In this randomized, double-blind study, 4202 patients with T2DM and established CV disease were assigned to either omarigliptin 25 mg q.w. or matching placebo in addition to their existing diabetes therapy. A Cox proportional hazards model was used to summarize the primary endpoint of time to first major adverse CV event (MACE, the composite of CV death, nonfatal myocardial infarction, and nonfatal stroke) and the analysis of first event of hospitalization for heart failure (hHF).

Results

The median follow-up was approximately 96 weeks (range 1.1–178.6 weeks). The primary MACE outcome occurred in 114/2092 patients in the omarigliptin group (5.45%; 2.96/100 patient-years) and 114/2100 patients in the placebo group (5.43%; 2.97/100 patient-years), with a hazard ratio (HR) of 1.00 (95% confidence interval [CI] 0.77, 1.29). The hHF outcome occurred in 20/2092 patients in the omarigliptin group (0.96%; 0.51/100 patient-years) and 33/2100 patients in the placebo group (1.57%; 0.85/100 patient-years), with an HR of 0.60 (95% CI 0.35, 1.05). After 142 weeks, the least-squares mean difference (omarigliptin vs. placebo) in glycated hemoglobin levels was −0.3% (95% CI −0.46, −0.14). The numbers of patients with adverse events, serious adverse events or discontinued from study medication due to adverse events were similar in the omarigliptin and placebo groups.

Conclusions

In this CV safety study of patients with T2DM and established CV disease, omarigliptin did not increase the risk of MACE or hHF and was generally well tolerated.

Trial registration ClinicalTrials.gov: NCT01703208. Registered 05 October 2012

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-017-0593-8) contains supplementary material, which is available to authorized users.

Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from Latin America

OBJECTIVE

This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from Latin America.

RESEARCH DESIGN AND METHODS

Analyses were performed in subgroups of patients from Latin America based on data from three individual, 26-week, placebo-controlled studies of canagliflozin (monotherapy [n = 116/584], add-on to metformin [n = 199/918], and add-on to metformin plus sulfonylurea [n = 76/469]) and three individual, 52-week, active-controlled studies of canagliflozin (add-on to metformin versus sitagliptin [n = 240/1101], add-on to metformin versus glimepiride [n = 155/1450], and add-on to metformin plus sulfonylurea versus sitagliptin [n = 156/755]).

MAIN OUTCOME MEASURES

Changes from baseline in HbA1c, body weight, and systolic blood pressure (BP) with canagliflozin 100 and 300 mg versus placebo or active comparator (i.e., sitagliptin or glimepiride) were evaluated in the overall study populations and Latin American subgroups. Safety was assessed based on adverse event (AE) reports.

RESULTS

Canagliflozin 100 and 300 mg provided reductions in HbA1c, body weight, and systolic BP across studies in patients from Latin America that were generally similar to those seen in the overall populations of patients with T2DM. The AE profile in patients from Latin America was equivalent to that in the overall populations; higher rates of genital mycotic infections and osmotic diuresis-related AEs were seen with canagliflozin versus comparators. Limitations of this study include the post hoc analysis of data and the small sample size of patients from Latin America.

CONCLUSION

Canagliflozin improved glycemic control, reduced body weight and systolic BP, and was generally well tolerated in patients with T2DM from Latin America.

CLINICAL TRIAL REGISTRATION

NCT01081834; NCT01106677; NCT01106625; NCT00968812; NCT01137812.

Hypoglycemic and antihyperglycemic effects of phytopreparations and limonoids from Swietenia humilis

An aqueous extract from the seeds of Swietenia humilis (31.6-100mg/kg bw) lowered (p<0.05) blood glucose levels in normal and nicotinamide-streptozotocin (NA-STZ)-induced hyperglycemic mice. Furthermore, when administered to fructose-fed rats with metabolic syndrome, the decoction showed significant antihyperglycemic, hypoglycemic and hypolipidemic effects, as well as an augmentation of hepatic glycogen. Limonoids 2-hydroxy-destigloyl-6-deoxyswietenine acetate (1), humulin B (2), methyl-2-hydroxy-3-β-isobutyroxy-1-oxomeliac-8(30)-enate (3), methyl-2-hydroxy-3-β-tigloyloxy-1-oxomeliac-8(30)-enate (4), humilinolide G (5), humilinolide C (6), methyl-2-hydroxy-3-β-isobutyoyl-8α,30α-epoxy-1-oxo-meliacate (7), and humilinolide H (8), were isolated from a CH2Cl2-MeOH (1:1) extract of the seeds. Compounds 5 and 8 are analogs of compounds 6 and 7. The structure of 5 was unequivocally established by X-ray analysis. When tested in normal and NA-STZ-hyperglycemic mice, compounds 1, 2, and 4 (3.16-31.6 mg/kg bw) decreased glycemia during an oral glucose tolerance test. The present investigation sustains the contemporary popular uses of S. humilis seeds for treating metabolic disorders, including diabetes and dyslipidemia and demonstrates the potential of the mexicanolides as antihyperglycemic agents.